Miscarriage or
pregnancy loss is not uncommon, but only about 1% of women suffer 3 or more
consecutive losses1; the probability of
recurrence increases with maternal age and the number of previous pregnancy
losses.2 Most expert groups agree that
couples with 3 or more consecutive pregnancy losses should undergo thorough
evaluation.3,4 However, many clinicians
test for causative disorders after 2 consecutive losses, perhaps because
couples often become distressed at this point.2
Although most (50% to 75%) cases of recurrent miscarriage remain unexplained,
identifying the underlying cause can be a first step toward appropriate
management.3

Recurrent
miscarriage has many proposed causes but is most strongly associated with
genetic, uterine, and thrombophilic abnormalities.3,5
Thus, initial evaluations may include parental cytogenetic analysis, a
maternal pelvic ultrasound to detect uterine structural abnormalities, and
karyotyping of products of conception to detect fetal aneuploidy.3,5
Women should be tested for antiphospholipid syndrome (APS), an acquired
thrombophilic disorder that is associated with 5% to 15% of recurrent
miscarriages.3-6 Screening for inherited
thrombophilic disorders may also be useful; some studies suggest a stronger
link with second- and third-trimester losses than with first-trimester losses.3,4

Thrombophilic
disorders represent a potentially treatable cause of recurrent miscarriage,
and accurate identification may help in designing therapeutic strategies. For
example, combined aspirin and heparin therapy appears to improve pregnancy
success in women with recurrent miscarriage associated with antiphospholipid
antibodies.3,4 However, the benefit of
antithrombotic therapy in recurrent miscarriage caused by inherited
thrombophilia has not been established.4
The Recurrent Miscarriage Evaluation/Coagulation Panel helps to identify the
most common acquired and inherited thrombophilic causes of recurrent
miscarriage. The panel also detects several rarer, but important,
thrombophilia-related causes (deficiencies in antithrombin III, protein C, and
free protein S).

Individuals
Suitable for Testing

Women who have
had ≥2 consecutive, unexplained
pregnancy losses

Because normal
pregnancy is associated with elevated fibrinogen and factor VIII (which
affects lupus anticoagulant test results) as well as reduced free protein S,
the panel is not recommended for use in pregnant women.7

b
This test was developed and its performance characteristics have been
determined by Quest Diagnostics Nichols Institute. It has not been
cleared or approved by the U.S. Food and Drug Administration. The FDA
has determined that such clearance or approval is not necessary.
Performance characteristics refer to the analytical performance of the
test.

c
Additional assistance in interpretation of results is available from our
Genetic Counselors by calling 1-866-GENE-INFO (1-866-436-3463).

d
Includes partial thromboplastin time assay modified for lupus
anticoagulant detection (PTT-LA) with reflex to hexagonal phase confirm
and dilute Russell’s viper venom time (dRVVT) assay with reflex to dRVVT
confirm and dRVVT mixing study. Reflex tests are performed at an
additional charge and are associated with an additional CPT code.

Detection of any
of the following is consistent with an inherited thrombophilic cause of
recurrent miscarriage: prothrombin gene mutation (20210G>A) or factor V
(Leiden) mutation (1691G>A; R506Q); elevated homocysteine levels; or
deficiencies in antithrombin III, protein C, or free protein S.3,11

The panel does
not identify non-thrombophilic causes of recurrent miscarriage.3
Test results are affected by methotrexate and warfarin as well as by liver
disease, kidney disease, and disseminated intravascular coagulation.11,12